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In a multicultural society, individuals from diverse linguistic backgrounds may face language barriers when seeking healthcare. Effective communication is essential to ensure that patients can accurately express their symptoms, concerns and medical history, and understand the information given to them by healthcare providers. In this blog, Kathryn Alevizos discusses some of the common language barriers non-native English speaking patients can experience, and offers practical advice on how we can all improve our intercultural communication skills. Why is inclusive intercultural communication important in healthcare? Effective communication between healthcare providers and non-native English speaking patients is essential for accurate diagnosis and treatment. Of course, communication also plays a significant role in patient safety. Clear and concise communication among healthcare team members helps prevent errors, such as medication mix-ups or misinterpretation of instructions. In addition, communication helps build trust and rapport between healthcare providers and patients. When patients feel heard, understood and respected, they are more likely to actively participate in their own care and follow treatment plans. What steps can we take to make our language easier to understand? There are many ways we can adjust our language, but below are four good starting points: 1. Add pauses when you speak Slow down and, more importantly, add pauses when you’re speaking so that your patient has time to process what you’re saying. If English is not your patient’s first language, it may take them longer to digest what is being said, work out their response and then find the right words in English to reply. Although we often feel uncomfortable with silences in our conversation, these pauses can be critical to a patient’s understanding. Adding pauses also supports active listening and will help you respond appropriately to your patient’s language level. On a final point, including pauses can make your accent easier to understand. 2. Reduce idiomatic language and paraphrase when necessary There are approximately 25,000 idioms in the English language! This is why we have to be mindful when we use them with non-native English speaking patients as it’s impossible to know which ones they will know. Expressions such as ‘nip it in the bud’, ‘bear with me’ and ‘feeling out of sorts’ can leave your patient confused, adding to any potential stress. It’s unrealistic to stop using idiomatic language completely but try to paraphrase where possible; for example, I hear you’re a bit under the weather, feeling unwell. 3. Avoid (or at least explain) acronyms and abbreviations Healthcare is full of specialist terminology and acronyms. These are particularly difficult for patients who speak English as an additional language. Even everyday terms such as ‘GP’ and ‘A&E’ may be unfamiliar as well as non-medical acronyms such as ASAP. The fact that certain letters can sound very similar, for example ‘p’ and ‘b’ or ‘f’ and ‘s’, compounds the problem. So when you use them for the first time, explain what you mean. If there are numerous terms associated with a particular health condition or treatment, consider giving your patient a written glossary of terms. 4. Use direct questions The language we use is often very indirect and this is particularly true of how we structure questions and instructions. We instinctively add unnecessary language in order to ‘soften’ our request or to come across as friendly and polite. For example, we may say "I was wondering whether we could have a quick chat about your medication?" rather than the much more straightforward "Could we talk about your medication?" It’s important to keep questions short, simple and direct. You can create a friendly manner through facial expressions and using your patient’s name. Call for action Awareness of how we can all adapt our language to better meet patient’s needs is key. While health organisations regularly make use of translators and interpreters, many are unaware of the intercultural communication training that members of staff can take part in to support and enhance their communication skills. By making health organisations more language aware, staff can start to implement simple strategies that will improve patient safety and optimise their healthcare experience. Related reading on the hub: Accessible patient information: a key element of informed consent (by Julie Smith) CardMedic: Empowering staff and patients to communicate across any barrier

Sunday 16 January 2022 marked World Religion Day. Around half of the UK population identify with a faith tradition, and in this blog, Jeremy Simmons, Policy and Programme Officer at FaithAction, highlights the important role of faith-based organisations in addressing health inequalities and helping people access healthcare. FaithAction is a national network of faith-based and community organisations seeking to serve their communities through social action and by offering services such as health and social care, childcare, housing and welfare to work. A few months ago, a friend of mine began to experience some worrying symptoms; he was diagnosed by his GP with anxiety and depression, and prescribed antidepressants. Like around half of the UK population,[1] my friend identifies with a faith tradition, and when he felt hesitant about taking the medication he’d been prescribed, his first port of call was to talk to a faith leader he trusted, who listened to his concerns and encouraged him to pursue the treatment he had been prescribed by his doctor. My friend did feel able to begin his treatment, and is doing much better. Supporting people through treatment is just one of the ways that faith communities facilitate patient safety. Here are three reasons why faith groups play an important role in the health of their communities: 1. Faith can reach to the heart of communities who struggle to access services I was at a meeting last year where an NHS director said he thought the rollout of the Covid-19 vaccine would not have been such a success were it not for the involvement of faith groups. Why? The willingness of so many mosques, churches, gurudwaras and temples countrywide to support messaging and open their doors as vaccine centres, meant healthcare crossed from the domain of waiting rooms and blue scrubs into spaces of commitment, familiarity and trust. People were able to begin having conversations about the efficacy and safety of vaccines in spaces that felt safe to them. The vaccine rollout is an example of just one area in which faith groups have been employed as trusted messengers within communities. The reality is, there are population groups in England who, for one reason or another, are insulated from much health messaging. It’s not that they are ignoring or misunderstanding the messages, they are simply not getting them. To give just one example, a faith organisation I know runs a befriending scheme in a deprived part of East London. I was talking to one of the organisers last October and she told me that she had just been explaining how to take a lateral flow test to a local couple. It was the first time this couple had seen or heard of these tests. For whatever reason, they hadn’t been able to access government and NHS messaging about rapid testing - but they had accessed this faith-based support group, and that made the difference. It is often said that no one is “hard to reach”, we just aren’t finding the right ways to reach them. Given the success of using faith centres in the Covid-19 vaccine rollout, what would be the potential in forging partnerships around such things as cancer screening or pregnancy and antenatal care, areas where huge health inequalities persist? 2. There is a link between faith groups and health inequalities Whilst it may be difficult to say a lot about the health inequalities that people of faith experience (very little data is routinely collected around faith and health) there are clues that indicate a link between faith and health outcomes. For example, the correlation between poverty and health inequality is well documented, and, after accounting for ethnicity, certain religions are at higher risk of experiencing poverty.[2] Just under half (46%) of the Muslim population, for example, live in the 10% most deprived, and 1.7% in the least deprived, Local Authority Districts in England.[3] Sikhs are also shown to be at greater risk of poverty than people from other faith traditions.[4] The pandemic has highlighted these trends, with ONS data demonstrating disproportionality in Covid-19 outcomes not just according to ethnicity but also faith, in part owing to socio-economic factors.[5] What can we conclude? If there are meaningful links between faith and inequality, then part of the way to tackle inequality must surely be to involve faith organisations. Faith organisations’ assets for health promotion (things like space, transport, time and willing volunteers) mean they are ideal places to run interventions and be involved in prevention initiatives. As we’ve seen, where this approach has been adopted in the pandemic it has been effective, suggesting the potential for more targeted work going forward. 3. Faith groups are often ‘first in and last out’ at the point of need Last year I was involved in surveying over 100 FaithAction members to build a picture of what work they had been doing in support of the NHS during the pandemic. I expected to discover a long list of activities (my conversations with faith groups this past year has left me in no doubt that they have been very busy). What I wasn’t expecting was that much of this activity was already well underway even before the pandemic hit. To give a few examples, over a third of the organisations surveyed were already helping patients with telephone or digital consultations before the pandemic. Just over 32% were already helping people make contact with health and care organisations, and 36% were providing transport to and from appointments. What this indicates is that when GP consultations became primarily digital in April 2020 these charities were already poised to help their beneficiaries connect. The survey also revealed faith groups delivering food and medication, offering support with mental health, supplying PPE and tackling misinformation. That faith-based organisations are “first in and last out” where need arises is a bit of a catchphrase at FaithAction. And yet it rings true, never more so than during the pandemic. We’ve witnessed faith-based organisations up and down the country respond with characteristic compassion, agility and innovation. And they continue to respond, even against a backdrop of funding shortages, limited resources and disruptions to normal activity and worship practices. You could say that the role of faith-based organisations during the pandemic has been something of a microcosm for the kind of cross-sector partnerships that might be built across the wider health and care landscape looking ahead. I think it shows the potential for a kind of creative thinking that seeks to strengthen partnerships across sectors for the benefit of our diverse communities. References 1 J Curtice, E Clery, J Perry et al. British Social Attitudes: The 36th Report. The National Centre for Social Research, 2019 2 M Marmot, J Allen, P Goldblatt et al. Fair Society, Healthy Lives – The Marmot Review: Strategic review of health inequalities in England post-2010. Institute of Health Equity, 2010;p38 3 Beckford, J. Review of the Evidence Base on Faith Communities. Office of the Deputy Prime Minister, 2006. Accessed 25 June 2021 4 Reducing poverty in the UK: A collection of evidence reviews. Joseph Rowntree Foundation, 2014. Accessed 25 June 2021 5 Rates of deaths involving COVID-19 by religious group, England and Wales. Office for National Statistics website. Last accessed 18 January 2022